Findings: Oblique, comminuted fracture of the distal fibular diaphysis with a "butterfly" fragment. Mild posterior displacement and no gross angulation. The tibiofibular syndesmosis is widened and the medial mortise joint space is widened due to mild lateral talar shift.

Discussion: The eponym "Dupuytren fracture" has been used to describe this injury. Commonly used ankle classification systems include the Danis-Weber system, which is based on the level of fibular fracture relative to the tibio-talar joint level and the Lauge-Hansen system which is a more complicated system describing position of the foot and direction of force at the time of injury. (see links below for more detailed description of these systems. This fracture would be a Type C, according to the Weber system (see diagram).

Malleolar fractures in ankle sprain injuries are frequently the result of force applied by or through the talus. Tension force to a malleolus results from ligamentous attachments and compression or torsional type force results from to bone-to-bone contact. Tension forces are more likely to result in a horizontal fracture plane across a malleolus and compression/torsional type force is more likely to create an oblique fracture plane. If the talus has moved sufficiently to cause diastasis of the tib-fib joint and fracture the fibula, then medial side injury in the form of either horizontal medial malleolar fracture or deltoid ligament rupture is very likely (see diagram)

The reader is fully responsible for confirming the accuracy of this content. Text and images may be copyrighted by the case author or institution.You can help keep MyPACS tidy: if you notice a case which is not useful (e.g. a test case) or inaccurate, please contact us.